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In the 2nd night of the Democratic Primary debate on June 27,
2019, Pete Buttigieg was asked whether he supported
Medicare-For-All. He responded, “I support Medicare for all who
want it.”

In doing so, he side-stepped the controversial debate over shifts
of power from states to the federal government, and trusted that
logic would eventually prevail over a collusive
Medical-Industrial Complex with an iron lock grip on a system
that deals everyone imaginable in on the sickness profitability
curve – except the patient.

My first job after residency was in a small mill town in central
Maine. I joined two fifty something family doctors, one of whom
was the son of the former town doctor. I felt like I was Dr.
Kiley on “Marcus Welby, MD.” I didn’t have a motorcycle, but I
did have a snazzy SAAB 900.

Will was a John Deere man, wore a flannel shirt and listened to A
Prairie Home Companion. He was kind and methodical. Joe didn’t
seem quite as rural, moved quicker and wore more formal clothes.
I never could read his handwriting.

Far more attention has been devoted to the ways in which industry
consolidation has driven up health costs than to proposals on how
to remedy the situation. But the introduction of Medicare for All
and Medicare for More bills—however dim their short-term
prospects are—has changed the terms of the debate.

There I was, my 10th-grade science fair. My mother made sure I
had a tie that fit properly and a shirt that was perfectly
pressed. I stood among my peers with our cardboard presentation
displays highlighting what we did to make it to this point. I was
a little nervous but also extremely proud of myself and excited
to see the looks on the judge’s faces when they saw what my
project was about:

I’ve been talking in recent posts about how our typical methods
of testing AI systems are inadequate and potentially unsafe. In
particular,
I’ve complained that all of the headline-grabbing papers so
far only do controlled experiments, so we don’t how the AI
systems will perform on real patients.

Today I am going to highlight a piece of work that has not
received much attention, but actually went “all the way” and
tested an AI system in clinical practice, assessing clinical
outcomes. They did an actual clinical trial!

Burnout is one of the biggest problems physicians face today. We
believe that addressing it early — in medical school — through
coaching gives physicians the tools they need to maintain balance
and meaning in their personal and professional lives.

We say that after reading comments from participants in our
coaching program, “A Whole New Doctor,” developed at Georgetown
University School of Medicine.

The high cost, low quality and systemic inequities of the U.S.
healthcare system have been the impetus for its redesign. Our
healthcare system is now controlled by Consolidated Healthcare
institutions, Insurance companies, Pharmaceutical companies and
Health Information Technology companies (CHIPHIT complex). The
CHIPHIT complex, along with the Federal Government, will create
and control our future healthcare system.

Health insurance companies are standing in the way of many
patients receiving affordable, quality healthcare. Insurance
companies have been denying patient claims for medical care, all
while increasing monthly premiums for most Americans. Many of the
nation’s largest healthcare payers are private “for-profit”
companies that are focused on generating profits through the
healthcare system. Through a rigorous approval/denial system,
health insurance companies can dictate the type care patients
receive.

A
survey of 200 physicians under the age of 35 showed that 56%
reported unhappiness with the current state of medicine. That
number didn’t seem surprising to me at first. I was not
particularly “happy” at the time of reading this survey either.

I’ve aspired to become an oncologist for as long as I can
remember. In oncology, despite my inability to cure, I can always
try to heal. I form connections with patients and their families
as they embark on a journey that is quite often their last. I
learn from my patients as much as, and at times more than, they
learn from me.

But all of this is overshadowed by a sense of heaviness that I
frequently encounter as I enter the clinic room. That sense of
heaviness hits when a patient tells me of the time when they were
placed on a “brief hold” for more than half an hour in order to
reach someone to get a prescription refilled or reschedule an
appointment. Or when their insurance refused to cover the drug
that I had prescribed to them. It is when I hear that clinic
visits or treatments are not scheduled due to insurance
authorization delays. Or when I’m asked about the cost of drugs
and end up having to explain how nobody really knows.

In the 20th century, hospitals completed their transformation
from the hospice-like institutions of the Middle Ages, into
large, gleaming centers of advanced medical expertise and
technology that save and improve lives every day. But an
unintended consequence of hospitals’ dazzling capabilities is a
staggering cost burden that’s proving toxic to the American
economy.

Today, hospital care accounts for approximately 33% of the US’
$3.5 trillion annual health care expenditures, according
to CMS. The drivers of hospital costs are complex and hard to
tackle, including (but not limited to) market consolidation that
enables price hikes, heavy administrative burdens, expensive
technology and patient usage patterns.

Fifteen years ago, as a medical student, I learned a terrifying
lesson about blindly using race-based medicine. I was taking care
of Mr. Smith, a thin man in his late 60s, who entered the
hospital with severe back pain and a fever. As the student on the
hospital team, I spent over an hour interviewing him, asking
relevant questions about his medical and social history, the
medications he took, and the details of his symptoms. I learned
Mr. Smith was a veteran who ran into tough times that left him
chronically homeless, uninsured, and suffering from hypertension
and diabetes.

In my mid-twenties, I was twice prescribed the common
antihistamine Benadryl for allergies. However, my body’s reaction
to the drug was anything but common. Instead of my hives fading,
they erupted all over my body and my arms filled with extra fluid
until they were almost twice normal size. I subsequently
described my experience to a new allergist, who dismissed it as
“coincidence.”

When I later became a nurse, I learned that seemingly “harmless”
medications often cause harm, and older adults are particularly
vulnerable. Every year, Americans over age 65 have preventable
“adverse drug events” (ADEs) that lead to 280,000 hospital stays
and nearly 5 million outpatient visits. The Lown Institute in
Boston draws attention to this underrecognized problem in their
recent report, Medication Overload:
America’s Other Drug Problem. Policymakers, patients, and
health professionals must act, because over the next decade,
medication overload is predicted to cause 4.6 million
hospitalizations of older Americans and 150,000 premature deaths.

Jenny, a woman in her twenties with morbid obesity (not her real
name), had already been through multiple visits with specialists,
primary care physicians (PCPs), and the emergency department (ED)
for unexplained abdominal pain. A plethora of tests could not
explain her suffering. Monthly visits with a consistent primary
care physician also had little impact on her ED visits or her
pain.

Many of you have received the email: Microsoft HealthVault is
shutting down. By some accounts, Microsoft has spent over $1
Billion on a valiant attempt to create a patient-centered health
information system. They were not greedy. They adopted standards
that I worked on for about a decade. They generously funded
non-profit Patient Privacy Rights to create an innovative privacy
policy in a green field situation. They invited trusted patient
surrogates like the American Heart Association to participate in
the launch. They stuck with it for almost a dozen years. They
failed.

As news of Tom Brokaw’s cancer diagnosis spreads, so does his
revelation that his cancer treatments cost
nearly $10,000 per day. In spite of this devastating
diagnosis, Mr. Brokaw is not taking his financial privilege for
granted. He is using his voice to bring attention to the millions
of Americans who are unable to afford their cancer treatments.

My patient Phil is among them. At a recent appointment, Phil
mentioned that his wife has asked for divorce. When I inquired,
he revealed a situation so common in oncology, we have a name for
it: Financial Toxicity.

As U.S. providers continue their slow but steady march away from
fee-for-service reimbursement and toward
value-based payments, they’re increasingly seeking means of
addressing patients’ health-related social needs. That’s because
social determinants of health—life circumstances including
socioeconomic status, housing, education, and employment—are
estimated to have at least twice the impact on risk of premature
death than health care. So addressing them is an important part
of value-based strategies aiming to improve health while reducing
health care costs.

Bayer’s G4A team launched their 2019 program today, so here’s a
little help for anyone curious about the state of pharma startup
investment and what it takes to land a deal there these days.

I had the chance to pick the brain of Bayer’s Global Head of
Digital Health, Eugene Borukhovich, during JP Morgan Healthcare
Week and pulled out these three gloriously thought-provoking
soundbites from our conversation to give you some insight as to
the mindset over at big Bayer.

Most will be surprised to learn that American Indians and Alaska
Natives represent the only populations in the United States with
a legal birthright to health care.[1] Even though Article
25 of the UN’s Universal Declaration of Human Rights
declares, “everyone has the right to a standard of living
adequate for the health and well-being of himself and of his
family, including…medical care and necessary social services,”
U.S. federal policy only guarantees this human right to enrolled
tribal members. The source of this juridical entitlement is what
the United States Supreme Court has defined as the federal trust responsibility.

Within the ever-widening array of Democratic contenders for the
Presidency, the “Medicare-for-all” debate continues to simmer. It
was only
six weeks ago that Kamala Harris’s vocal support drew fire
from not one, but two billionaire political rivals.
Michael Bloomberg, looking for support in New Hampshire
declared, “I think we could never afford that. We are talking
about trillions of dollars… [that] would bankrupt us for a long
time.” Fellow billionaire candidate
Howard Schultz added, “That’s not correct. That’s not
American.”